At 75 Years, Is Lithium the Gold Standard in Bipolar Disorder?

Lithium was the first discovered mood stabilizer for bipolar disorder. However, several antiepileptics such as valproate and carbamazepine have also proven to be mood stabilizers in all phases of bipolar disorder with profiles barely distinguishable from lithium. Second-generation antipsychotics were slowly recognized in almost all cases to be useful in all phases of bipolar disorder. These different treatments have not been found to have any common mechanism of action. Indeed, lithium itself has numerous biochemical effects that are often not replicable. The newest biochemical effects described for lithium are exciting but are still merely promising and should not be taught to medical students as facts, especially since they do not explain the fact that several antiepileptic and second-generation antipsychotics also work well in all phases of bipolar disorder. Lithium is not specific to bipolar disorder but has uses in several other psychiatric and nonpsychiatric conditions. Lithium, like most treatments in medicine, is nonspecific; it is still useful in many cases, but is not in any sense a “gold standard”.